Prevention of Postoperative Venous Thromboembolism in Thoracic Surgical Patients: Implementation and Evaluation of a Caprini Risk Assessment Protocol

Hachey, Krista J.; Sterbling, Helene M.; Choi, Daniel S.; Pinjic, Emma; Hewes, Philip D.; Múñoz, Juan José; McAneny, David; Tripodis, Yorghos; Fernando, Hiran C.; Litle, Virginia R.

doi:10.1016/j.jamcollsurg.2015.12.003

Cited by 58 publications

(37 citation statements)

References 27 publications

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“…Per the RAM protocol, patients with high‐risk scores were prescribed 30 days of postoperative daily enoxaparin prophylaxis, whereas patients at moderate risk received 10 postoperative days of treatment. Implementation of a VTE risk assessment protocol with extended course prophylaxis in high‐risk patients was safe and feasible for providers and thoracic surgical patients …”

Section: Multidisciplinary Therapymentioning

confidence: 99%

Recent advancements in esophageal cancer treatment in Japan

Tanaka

Yoshida

Suetsugu

et al. 2018

Annals of Gastroent Surgery

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The 11th edition of the Japanese Classification of Esophageal Cancer (EC) was published in 2017. Some correction was made in the depth of tumor invasion to be consistent with the TNM classification by the Union for International Cancer Control (UICC). With regard to surgery, short‐term safety and long‐term effectiveness under thoracotomy/video‐assisted thoracoscopic surgery are expected to be proven by the Japan Clinical Oncology Group (JCOG)1409 study. Results of nutritional management and countermeasures for adverse events not only during the perioperative period but also during EC chemotherapy were reported. From now on, the pursuit of low invasiveness and radicality is desired. Esophageal surgery is also expected to be safe at all institutions. To determine the optimal modality of preoperative treatment and a novel chemo(radio)therapy regimen for patients with distant metastasis, the results of the ongoing JCOG1109 and 0807 studies are being released. The effect of the addition of molecular targeted drugs on chemotherapy and concurrent chemoradiation has not yet improved overall survival. Immune checkpoint inhibitor drugs could offer a potential new treatment approach for patients with treatment‐refractory advanced squamous cell carcinoma (SCC). The Cancer Genome Atlas Research Network reported the results of a comprehensive genome analysis and molecular analysis of SCC and adenocarcinoma of the esophagus. Further differentiation of SCC and adenocarcinoma by molecular characterization analysis may be useful for the development of clinical trials and targeted drug therapies as precision medicine. The era of ultimate minimally invasive surgery and personalized treatment has begun. Large, prospective studies will be required to confirm the value of these advancements.

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Section: Multidisciplinary Therapymentioning

confidence: 99%

Recent advancements in esophageal cancer treatment in Japan

Tanaka

Yoshida

Suetsugu

et al. 2018

Annals of Gastroent Surgery

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“…This is the first clinical evidence of the effect of enoxaparin on INR in patients undergoing abdominal surgeries. Enoxaparin had been shown to be effective in reducing the risk of thromboembolic events in patients undergoing thoracic and orthopedic surgeries . In this study, we demonstrate an increase in the INR for hepatobiliary patients who received enoxaparin for post‐operative VTE prophylaxis.…”

Section: Discussionmentioning

confidence: 51%

“…Low‐molecular‐weight heparins have been previously shown to be safe and effective in the treatment of venous thrombosis . Enoxaparin (Lovenox) is a low‐molecular‐weight heparin drug that is used regularly for the prophylaxis of thromboembolic events in patients undergoing invasive surgery . It functions to inactive prothrombin (factor Xa) via a complex formed with circulating anti‐thrombin III .…”

Section: Introductionmentioning

confidence: 99%

Clinical effect of enoxaparin on international normalized ratio following hepato‐pancreatico‐biliary and gastroesophageal resection

Kelecy

Shutt

Rostas

et al. 2018

Journal of Surgical Oncology

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“…24 Nonadherence to guidelines continues to be a significant issue, and likely contributes, at least in part, to stable or increasing incidence of in-hospital VTE. 22,25 Inadequate or inaccurate risk estimation has been shown to lead to poor outcomes. 26 The causes of this are multifactorial.…”

Section: The Institution Of Risk Assessment In the Hospital Systemmentioning

confidence: 99%

“…Hachey et al investigated the effectiveness of risk stratification with the Caprini RAM in a cohort of thoracic surgery patients. 25 The authors' institution (Boston University) uses the Caprini RAM for all surgical patients preoperatively, and categorizes patients similarly to other institutions, with low risk (0-4), moderate risk (5)(6)(7)(8), and high risk (9). Of 126 patients analyzed, 19.2% fell in the high-risk, 48% in the moderate-risk, and 32.8% in the low-risk category, and overall VTE rate was 2.3%.…”

Section: Cardiac and Thoracic Surgerymentioning

confidence: 99%

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Jacobs

Pannucci

2017

Semin Thromb Hemost

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Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

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Prevention of Postoperative Venous Thromboembolism in Thoracic Surgical Patients: Implementation and Evaluation of a Caprini Risk Assessment Protocol

Cited by 58 publications

References 27 publications

Recent advancements in esophageal cancer treatment in Japan

Recent advancements in esophageal cancer treatment in Japan

Clinical effect of enoxaparin on international normalized ratio following hepato‐pancreatico‐biliary and gastroesophageal resection

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

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